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It is time for Congress and the President to legislatively create health care changes that produce cost containment and better results.  The United States has no proof that its spending level which is way above the rest of the industrial nations has increase the health of its people or their longevity.    When such a measure is used for any year the United States health care system has failed to be cost efficient. It is time to say health care costs have failed to provide the better return. Therefore, health care needs to change to produce better results or its costs need to be lowered to be in line with other industrialized nations.   

It is time to make a whole change to the approach of home health care vs facility health care.  Just look at all of the construction being supported in the health care field as the measure of whether the health care system is at fault for promote facility care over home care.   

Why does government policy or insurers make getting long term facility care for an individual easier than services to stay in their home?  It is time to have a tier system.  Use a standard the some states are practicing in the disability field for individuals called individual supports or Community Habitation. 

I have provided below an example to consider using an hourly rate of $8.76

Individual supports under 15 hours a week (up to 2 hours a day) up to $17.52 a day.

Individual Supports between 15-48 hours a week  (up to 6.86 hours a day) $18.75 to $60.09 a day

Individual supports between 49-105 hours a week (7- 15 hours a day) $61.32-$131.40 a day.

Each model is cheaper than the $158 per day that Massachusetts pays for nursing home care.  If an individual receives less than 5 hours a day for five days, their services are even less costly than a rest home, Adult Day Health or Social Day Care program.   

Fiscal woes should be about reducing institutional care and increasing community care.  Serving more people at the lesser cost service in their home creates better quality of life care and the ability of an individual to stay more healthy longer.  

2009 should be the year to remember that government no longer supports programs that do not show a measurable rate of return within a specific time table.  The experiment of the the United States spending more of its GNP on health care than other industrialized nations needs to end.  It has failed to meet the outcome standard of better outcomes for a higher price.

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Consumers and businesses make decisions every day that are base on the intake of information,  the processing of the information and when necessary a comparison is made.   The decision making process results in the management of a nonprofit making choices.  The decision making process is similar for a consumer making choices, with the exception that their pricing power is limited as an individual.

The lack of public information in pricing by health care providers and insurers creates a secret system for getting the best service for the best price.  The clarity of definitions of those services that are required to perform a service would make setting price and publishing those prices much easier for comparison by all.

The fact that individual organizations complain that their rate includes other services not provided by their competitors rate can easily be resolved by having the additional services listed and the note included in the rate.  If the additional service is mandatory that should be clear, since a CHOICE NOT TO RECEIVE THE SERVICE  is not optional.

The competitiveness of the market place requires rates and information.  Until such time as Congress passes legislation to mandate the publication of the information, pricing will always increase.

Congress needs to take advantage of the fact that Medicare and Medicaid are huge purchasers of health care and have defined every procedure, service or item and have been able to price for their level of reimbursement.   If a new  service, procedure or item needs pricing there is a procedure.

Therefore, the publication of rates and information already has the baseline for the lowest price.  Congress should mandate that all entities need to publicly post on line to a federally supported system their pricing.  This federal supported system will automatically load the Medicaid and Medicare rate information.  This will allow the businesses and insurer a stronger tool to create affordable health.

Recently I was able to review some public rate information in the Boston Globe.  The result is that I am serious looking into a great hospital in Cambridge Massachusetts called Mt Auburn Hospital.  Their outcomes are equal to the larger more expensive hospitals in my area.  With my deductible and flexible spending plan I will be able to afford more health care for my family by utilizing them.

It pays to compare.   If your looking as a nonprofit organization to stretch those health care employee benefit dollars be proactive in sharing the information with your employees.  An educated consumer is a smarter consumer.

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Annual 300 billion spent on drugs.
For over half the people the drugs will not work as intended.
Further, many of these people will experience a side effect, when it could have been avoided if personalized medicine was more readily supported and used. 

There is concern that there is not enough data on various treatments and more tests are needed to compare treatments, that genetic testing will cause insurers to deny coverage, and that genetic testing is not conclusive. 

The simple answer is that for every day a hospitalization is preventable due to genetic testing that shows the likelihood of how a drug will react to an individual, the more that it should be the norm that each of us has such data as part of our medical record.  It is not just about what a drug will do to an individual but about what environmental factors might do to an individual. 

The majority of health care organizations are nonprofit entities.  There are numerous individuals that are effected in the same way by a particular disease where a Foundation has been created to find a cure or treatment.  All of these organizations have a stake in supporting and promoting genetic profiling.    It will not only support more healthy individuals but lower health care costs. 

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On December 27, 2008 the Boston Globe carried an Associated Press article that reported on the isolation and restraining of mental patients.

I would summarize the article as focusing on those rare violent patients whom do not respond to medication or treatment that Mental Health officials have come to call outliers.   Advocacy groups say it is a system whom have given up on those most difficult to treat.  The US Supreme Court has already ruled it unconstitutional to isolate or restain a patient for extended periods.  However, Federal and State Law have a loophole that allows inpatient facilities to lock and/or restrain an individual away for the safety of staff and other patients.  While some patients sue most do not.   If you want to read the details of these efforts check out this link to the article.

Advocates have shown to be the best means to provide direction to better policies for giving the right supports to the mentally ill.  Is it time to make advocates a standard not an after the fact or lucky support to the mentally ill?   What would it take to keep the doctor away and stay healthy mentally?

(pic by jasonthegreat)

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Seek out corporations whom are willing to have their employees perform charitable work for your organization.  Companies do not usually advertise their commitment towards backing an employees’ volunteer effort.  This asking of an employer for their support should be structured to ensure that they will see a measurable result.

These companies usually pay the employees during this volunteer time.  Imagine showing this match when seeking other funding for your programs.  Imagine the success of one employee as a volunteer helping to identity for their fellow employee other potential volunteer opportunities.

During these tough economic times most companies are likely to keep up the efforts of their volunteer program.  Studies have shown that paid time off for volunteering can help a company in its recruiting and retention of employees.  Further, at an employees suggestion, companies often are willing to help out in bigger efforts for the nonprofit.

For more ideas on how to get corporations to invest in your organization check out the three documents noted below.

Giving in Numbers: 2007 Edition Link

Giving in Numbers:  2008 Edition Link

Business’s Social Contact: Capturing The Corporate Philanthropy Opportunity Link

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A means to lower health care costs is to create a focus on preventative services.  There is sufficient strength in the nonprofit sector to work together to promote health care services which are more affordable.

Mobile health care, on site clinics, and scheduling practitioners to go to the work place has shown to save money for health plans in the long run.  Expectation is to reduce overall health care spending by focusing on preventing illness.  Thus, an additional outcome of less illnesses is the increase in productivity.

1. Preventative services should be free
2. Treatment services should carry a co-pay
3. Savings due to services should result in lower premiums.
4. Services should augment primary care provider.

I would suggest nonprofits join and invest in an effort to create a cooperative that is supported by a per employee fee for its members to deliver a base health service to an organization’s employees.  Health care costs are a budget item that organizations need to be in more control of instead of depending on the health care industry to contain costs.

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New Year Resolution:

Expand use of the Internet

Promote organization on the web

Use web base systems for collecting information

Convert old record systems to web base system.

Convert facilities to energy efficiency systems

Support telecommuting

Support own industry and buy government or nonprofits bonds

Best wishes to all for an improved 2009.

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Debt swaps have gone from being a blessing to being the death to financial stability.

Tax-exempt bonds once had been viewed as worthy as municipal bonds due to the nature of government regulation.  However,  with municipal bonds being viewed less favorable, the same has occurred for tax-exempt bonds.

As municipal or nonprofits default on their debt service in 2009 it will cause  serious problems for government and nonprofits needing to finance debt.

I would suggest that certain nonprofits and municipalities look to bankruptcy to create the right amount of time to negotiate with bond holders, especially if it is the change in the financial markets that has created the current fiscal crisis for the organization.

However, due to the fact that some nonprofits and government entities are unable to make the necessary decisions to do what is best for the industry I think regulations should be in place allowing state governments similar measures that the SEC and Federal Reserve have in dealing with financial institutions.

The industry of $430 billion tax exempt bonds is too important to not be more strongly supported during this time of tight credit and illogical behavior of the financial markets.  These bonds are not from entities that represent investors seeking a return but rather are from entities whom are to accomplish public good.

(pics by wonderwebly, thelastminute, and vintfalken)

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The use of 529 Education Prepaid Plans allows families to lock in current tuition rates of the state higher education institutions.  How is that for creating value?  It is like a guaranteed returned.

You might ask what happens if the student does not end up going to college or their choice is another state or private.

Not to worry, the account can be used for any college but will be limited to any increase usually tied to the growth of in state tuition.

This may be the best conservative way to ensure growth in your investment of funds for future generations.

Foundations who are supporting youth in reaching a college education might just want to utilize this approach as well.

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Measuring quality in health care based on a five star system.  A helping hand in making tough decisions.

Key Measures:

1. State Health Inspections
2. Staffing
3. Various quality of care measures
4. Final score of overall quality

While the information relies on some data to be self reporting such as use of restraints or the frequency of infections it is a step in the right direction.

The rating system is the beginning of trustful tools for consumers to use in the selection of health care services. Find and compare Nursing homes by going to the Medicare web site. Click here for the link.

Other Tools on the Medicare site are the Medicare’s Guide to Choosing a Nursing Home, a Nursing Home Checklist and Your Rights as a Nursing Home Resident.

Join the movement of evidence base practice.  Help create or use a measuring standard for your organizations services.

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